Basic Information
| Provider Information | |||||||||
| NPI: | 1023082401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | COPELAIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE ELIZABETH PLACE | ||||||||
| Address2: | SUITE 10A | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372284156 | ||||||||
| FaxNumber: | 9372280247 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE ELIZABETH PLACE | ||||||||
| Address2: | SUITE 10A | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372284156 | ||||||||
| FaxNumber: | 9372280247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 01/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35044614 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 35044614 | OH | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0465741 | 05 | OH | MEDICAID |